Pain Management While on the Autoimmune Protocol

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Because NSAID (non-steroidal anti-inflammatory) medications are a suggested elimination while on the Autoimmune Protocol, I often get questions asking for alternatives. While you may need to remain on these medications (especially if your doctor advises you to) during the elimination diet, others like myself have been successful at finding alternatives to managing pain.

Why avoid NSAIDs while on the Autoimmune Protocol?

NSAID medications cause irritation to the lining of the small intestine, causing it to become more permeable (worsening “leaky gut” or intestinal permeability). One of the major goals of the elimination diet is to eliminate all substances (food, medication, or otherwise) that contribute to this inflammation and permeability of the gut.

The decision to eliminate NSAIDs is not an easy one — if you are in chronic pain you may not be able to do without, but it is in your best interest to check with your doctor to get guidance and see about alternatives. If at some point on the elimination diet, your pain is significantly decreased, you may be able to wean off of of them (with guidance from your doctor, of course). Whether or not you decide to forgo NSAIDs during your protocol is a personal decision and one best involving your doctor.

If you are experiencing daily, chronic pain (like that from rheumatoid arthritis) your decision may be different than if you are having occasional pain (like headaches or menstrual pain). For those who are interested in exploring a more natural approach to pain management, I have compiled a list of the following options I’ve experimented with myself that are not as hard on the gut as NSAIDs can be.

White Willow Bark

White willow bark is an herb (salix alba) that has the same active component (salicin) as NSAID medications, but instead of being intact, the molecule is digested and assembled outside the gut and thus does not affect the gut lining in the same way. Its mechanism of action is similar, making it a great alternative to NSAIDs. Unfortunately, because it needs to be fully digested before it can start working, it takes up to 2 hours to take effect. If you are trying to “get ahead” of pain, this task can be made very difficult by how slow-acting this remedy is.

When I have used white willow bark, I am sure to take it before I think I will need it, and then set a timer so that I am always “ahead” of the pain. This works in situations like menstrual pain, but doesn’t in the case of unexpected pain like a headache.

I’ve used this brand in the past at a dosage prescribed for me by my naturopath. White willow bark is a pretty safe herb, but those with an ulcer history, stomach problems, or bleeding disorders should be extra cautious. Be sure to do some research and consult your doctor if you are taking other herbs and/or medications or are going to be using it on a daily basis.

If you’d like to learn more about white willow bark, I’ve written an article about it here.

Ginger and Turmeric

Ginger (zingiber officinale) and turmeric (curcuma longa) have been used for thousands of years in ayurvedic and Chinese medicine to treat inflammation and pain, among other symptoms. This literature review found that both of these rhizomes are clinically effective at managing pain. Their mechanism of action seems to be similar to that of NSAIDs, making them a good alternative to consider.

While both turmeric and ginger can be taken in supplement form, sometimes even in combination, they can also be effectively used as spices in cooking, steeped in tea, or juiced fresh. I like to include a lot of fresh ginger and turmeric in my meals every week, and I get a bottle of this juice (caution seed spice reintro) when I am feeling especially achy. Both of these spices have such wonderful flavor that I actually prefer to use them liberally in my cooking, but for those with specific needs the measured dose that a supplement provides might be more simple.

Ginger and turmeric should be used with caution for those with bleeding disorders, as they tend to thin the blood. You should check with your doctor if you are on blood-thinning or other medications as they can be contraindicated here.

Cramp Bark

Cramp bark (viburnum opulus) is an anti-spasmodic herb that has been used for centuries for pain due to cramping. It works phenomenally well for menstrual pain, and is especially quick-acting (sometimes in a matter of minutes) when used in tincture form (caution for those very sensitive to gluten — it is very difficult to find products that are safe here, so do your research!).

I’ve used this brand at a dosage prescribed for me by my naturopath. Cramp bark is a pretty safe and well-tolerated herb, but be sure to do some research and consult your doctor if you are taking other herbs and/or medications concurrently.

Belly Breathing

A lot of times, pain can be due to muscle tightness, which is worsened by the way we tend to constrict the area of our bodies where we are experiencing this pain. Sometimes this can be relieved, either partially or in full, by belly breathing exercises. Here is a YouTube video with some great exercises you can try.

Don’t underestimate the power of this step. In my experience, it works more effectively for acute pain than chronic pain, but I’ve had many situations where my pain level has gone from through the roof to minimal just by getting my breathing under control.

My experience

I originally went off NSAIDs when I embarked on my elimination diet in 2012, as recommended by many of those advocating for the Autoimmune Protocol. Up until this point, I managed my monthly menstrual pain with Motrin (an NSAID). When I started feeling cramps on the first day of my period, I would take one pill and then repeat every 6 hours for the first 24 hours; with that treatment I had minimal pain and my life was unaffected.

When I attempted to get through that first cycle without NSAIDs, I was shocked to find out exactly how much pain I was in. It was a miserable experience that I did not want to relive. My sister introduced me to white willow bark, which provided just enough relief so that I wasn’t completely miserable, but my day was still interrupted. I learned to “take a day” whenever my cycle came.

After six months of being on the Autoimmune Protocol, as well as a good change in my thyroid medication, I found my monthly pain greatly decreased. I could now go without the white willow bark, and experienced minimal pain. This continued for over a year, and I attribute it to the favorable changes that go along with hormonal balancing. (I also experienced an elimination of my cystic acne during this time.)

About a year ago, something shifted however, and I experienced a return of my monthly pain (without a return of any other symptoms, thyroid or otherwise… which was puzzling). This time, white willow bark didn’t seem to put a dent in it, and I started exploring these other options. Today I’m happy to report I am no longer experiencing extreme pain during my cycle with the combination of turmeric and cramp bark. I start taking the turmeric a week before my cycle, and I drink the juice/cook with it on the first day of my period. I take the cramp bark tincture as prescribed by my naturopath, 6 to 8x/day while I have cramps. It really is an amazing herb, and works within minutes. With the combination of those supplements plus a heating pad and belly breathing, things are much more bearable.

Like I said, pain management while on the Autoimmune Protocol can be a tricky situation and not everyone may be able to completely go off of NSAIDs initially. If you’ve been considering alternatives, I hope this article has given you some ideas to explore.

Have I missed anything? What do you use to manage the pain without NSAIDs?

Mickey Trescott is a cook and one of the bloggers behind Autoimmune Wellness. After recovering from her own struggle with both Celiac and Hashimoto’s disease, adrenal fatigue, and multiple vitamin deficiencies, Mickey started to write about her experience to share with others and help them realize they are not alone in their struggles. She is a certified Nutritional Therapy Practitioner by the Nutritional Therapy Association, and is the author of The Autoimmune Paleo Cookbook, a guide and recipe book for the autoimmune protocol, and AIP Batch Cook, a video-based batch cooking program. You also can find her on Instagram.

44 comments

Ah, Angie. I feared my first period after starting the AIP!! (Only learned later that those menstrual cramps and Hashimoto’s go hand in hand). But was absolutely amazed that I could see it through without any help! It stayed like that for almost 6 months. Then my homeopath weaned me from synthetic thyroid meds (Eltroxin) and started me on Thyroid S (bovine). And wham, the pain is back! (I am still following strict AIP). Suppose we still need to get the correct dose….

So, as today is day 1, I am most thankful for this post! I’m going to order some drops just now.

Hey Marelize! While super painful periods can be a sign of endometriosis, which many of us with Hashi’s also have, it can be from hypothyroidism. Some people don’t tolerate certain thyroid medications as well as others, so you might not be on the right type, or dose to get that symptom to go away. Hope you start feeling better soon!

Hi! Thanks for these recommendations! Have you ever tried Zyflamend by New Chapter? I had an acupuncturist that had me on that for inflammation and pain relief. Wondering if you had any thoughts on the ingredients of that product?

Hi Sheri, I haven’t tried zyflamend, but I believe it has seed oils and potentially other ingredients that are not AIP. While I absolutely believe in the power of these anti-inflammatory compounds, there might be a better product for you if you are in the elimination phase. Or, if you tolerate seed oils + others you might want to give it a try!

I’m still looking for something to ease my joint pain / muscle pain- unfortunately. I have tried everything that I know of. Essential oils help a little . I also have tried a few tinctures from herb-pharm.com that also give a little relief . I have tried massage therapy , Accupuncture , chiropractic, topicals , homeopathic , herbal , natural and a strict diet without great success for over one year. Oh and I have been to a pain mngt. Dr but all of those drugs come with so many side effects . So I’m still searching. I do appreciate your article.

I had severe back and joint pain last year and had to go to the ER. The Dr. prescribed pain killers, which only masked the problem. I went to my local Vitamin Shop where I learned about WOBENZYM N for joint health. Within days my pain was gone! I have spoken to a pain management Dr. about this supplement and he has referred it to his patients with excellent results. I also add fresh ginger and fresh tumeric root juice to my brewed komucha for everyday aches or pains. Acupuncture is also excellent for general well-being.

I am male and experience adrenal fatigue, inflammation, and joint pain. I find that most of the people that participate in your forums are female. Is there a source geared toward men that you would recommend?

Hi! I could really use some direction for an upcoming surgery I will be having to repair hiatel hernia …..post surgery will be 10-14 days pure liquid transtioning to pureed foods…. need help sourcing/finding compliant foods for this period….appreciate any guidance!! Been AIP for almost 3 yrs….. (reintro coffee)….thank you …. Sincerely Lisa Wojnarowicz

Omega 3 supplements made a huge difference for me. Went from horrible pain to minimal after 2 months at 2000 EPA+DHA a day (6 standard strength capsules) Omega 3 is the precusor of anti-inflammatory prostaglandins. Menstrual pain is thought to be increased by pro-inflammatory prostaglandins. Eating lots of fish did not give me adequate omega 3 – I seem to need a lot.

Julianne, Thanks for adding this–I’ve known a lot of people who have done well upping their fish oil supplementation. I’ve got issues with biological amines and react to fish oil supplements, so haven’t been able to try it myself!

Thank you for this post Mickey! And I’m glad you’re back with us here. I caught your Sunday periscope and was very glad to hear from you! I am not currently experiencing extreme pain, and migraines have subsided for now. I’ve been on AIP since late January and successfully reintroduced mustard (seeds and my own homemade mustard from seeds, ground, salt, ACV and horseradish), but that is the only seed I’ve successfully introduced. My nutritionist and I have also successfully introduced eggs and now ghee/pastured butter. My AIP experience has seemed to be a few steps forward, then a few back. then a few steps forward, and a few steps back. Sometimes the steps backward have brought be back to before the steps forward, and sometimes a step ahead. I have lost 30 pounds and I’m very glad for that, however I haven’t really noticed less pain in shoulders, elbows, hands, hips or knees. For a while the ankle pain has been less, and I’m glad that hasn’t come back! And as of about 3.5 weeks ago the reflux finally went for good, except during the cold I currently am fighting. I’ve had chronic vertigo for about 7 years, likely partially due to CNS involvement in lupus. Now, besides the ‘normal’ vertigo I also have low blood pressure and orthostatic hypotension. What in AIP might be triggering that, or is it just part of my disease process, and AIP hasn’t yet addressed that problem? I am so very glad for this post about pain because I keep looking for alternatives to NSAIDS. There is a lot of good information in this article!! Thank you So Much Mickey and Angie!!

Hey Katie! Congrats on your progress, I am here to tell you the forwards-backwards-forwards again dance is very common in healing with AIP. It sounds like you’ve got some complicated autoimmune and health issues, which can make the healing process quite lengthly or require a lot of troubleshooting. I think it is great you are working with a nutritionist and I’d suggest continuing to look for root causes while working towards deeper healing with AIP. Wishing you the best!

I found that going to my acupuncturist right before menses seemed to help. I use to take vicodin and toradol my periods were SO BAD! Now I take systemic enzymes, turmeric and arnica and it seems tolerable. Interesting how hypothyroidism can cause more cramping.

Thank you for this. I have endometriosis and am phasing in paleo, but not yet AIP. Removing dairy helped a bit but I also wanted to mention homeopathic remedies and essential oils. Magnesium phosphate is the tissue salt that has helped so much, and as for the oils, I don’t sell them and don’t really care about one brand vs another, as long as they’re good quality, but making a “morphine bomb” has really helped. It tends to be a mix of any of the following oils, in a veggie cap: frankincense (anti inflammation I think) lemongrass, marjoram (antispasmodic), and white fir. I think the mix depends on the person, but this has helped decrease my NSAID use quite drastically – I used to have to take a week or more of back to back naproxen or toradol, plus constant heat (super hot water bottles and baths).

This article is very timely for me as I am home for the third day in a row with the worst menstrual cramps I’ve had in a long time. I was diagnosed with Hashimoto’s just a few months ago and went full AIP Elimination Diet + Hashi restrictions on April 1st…with the exception of NSAIDS…that is the one category that I have not been able to let go of yet, as I am always in pain. Otherwise, the diet has been an adjustment for sure, but not overly difficult. I admit that I am frustrated, though, that I have not lost a single pound yet, nor has any of my pain subsided…and in fact, I have taken MORE ibuprofen during this current cycle than I ever have! Is this normal for folks who are making major adjustments to their lives while also still fighting chronic fatigue, pain, and inflammation…to experience more pain initially during the elimination phase? Is my body freaking out due to the exposure? Admittedly, I haven’t struggled too much with the diet until now when I want my old comfort foods to ease the PMS and cramping. (Chocolate!) Do any of you have any AIP-PMS comfort foods you can recommend?

Thank you, Mickey, for this list of alternatives. I have been using cramp bark, but will look into the others as well. I have also used Helonias Root for cramps in the past, which does help quite a bit for quick relief for mild to moderate cramping. (Sold by Herb Pharm, based out of Oregon.) I also want to thank you for this blog and for the knowledge and advice that is shared here. (I have your cookbook, too!) Having a community to discuss these issues with is so extremely helpful and valuable…it’s a lot to learn and I am grateful for the outlet. Thank you!

Hi Sara! I’m sorry to hear of your recent diagnosis, as well as your worsening of pain. A couple things–first, I tell people not to freak out about weight loss when starting AIP. Our mission is first and foremost, health before image. With Hashimoto’s, there are a lot of hormones that need to come into balance and progress is rarely swift (especially in that common pain point, the weight gain!). While eventually, when things are in balance the weight will normalize more easily, but if you put too much pressure here in the beginning you may drive yourself crazy!

A couple ideas–some women with Hashimoto’s (myself included) don’t feel well without adequate thyroid hormone replacement. So it is still worthwhile to work with your doctor to find out if you need medication, and if you are already taking it, if the brand and dose are meeting your needs. This might be a big factor in the weight loss resistance. Next, you want to make sure you aren’t eating too low-carb. Insulin is needed for the conversion of thyroid hormones (t4 to t3 in the liver) and a lot of people mistakenly go too low-carb when they start AIP. Try to include things like sweet potato, winter squash, plantain, taro, yuca, at least once a day to keep your carb levels up.

Lastly, while it is normal to go through a little period of transition, that for some people can have them feeling worse, generally experiencing new symptoms or pain is not typical and I’d suggest in this case to get a Paleo-friendly or functionally trained doctor to help troubleshoot.

So happy you are here Sara, and wish you the best of luck troubleshooting and navigating this path to better health. It does take time and effort to find out what works for you, but so worthwhile in the end!

I have been trying to take fewer NSAIDs over the last few years (been dealing with chronic pain without a diagnosos since a little after having my son). I have Celiac disease and migraines (much reduced since figuring out gluten) so NSAIDs are my go to for migraine pain. I have found acupressure on my head, chiropractic regularly, and daily yoga decreases my chances of migraines along with eating and drinking enough. I would love to find something to help with my pain especially on the bad days. I have found that I have issues with anger after taking NSAIDs, which in chinese medicine is a sign of liver problems. I have been taking herbs for that and it helps a ton.

Something to consider with period pain is the chemicals in tampons and pads. When I switched to a silicone cup, my cramps were greatly reduced.

I look forward to reading more and working to adjust my diet! I have cut out dairy due to it increasig GI symptoms and pain but find it hard to get enough calories in me whenever I cut something from my diet.

Hi Jenn! Sorry to hear about your migraines, my mother suffers from them and I know from being around her how debilitating they can be. One thought, have you tried a low-histamine diet, or tracking your migraines to see if they correlate with your menstrual cycle? Just a couple troubleshooting thoughts if you haven’t thought of them yet.

Very good observation about the chemicals in tampons and pads. Many people forget that the skin is semi-permeable, and what we put on it can make its way into the body, disrupting hormones and the like. Thanks for sharing and wishing you luck!

I was recently diagnosed with Sjogren’s disease which is an Autoimmune disease. I am hoping that this type of eating and lifestyle change will alleviate a lot of the pain I am experiencing. From what I have read, it sounds like something I need to begin right away. I purchased your cookbook and am excited to try several of the recipes. Have you had anyone comment, that had this same disease, that has had success with pain management?

Hi Kelly! I don’t have Sjogren’s disease, so I can’t comment personally, but I do know many with rheumatoid arthritis (Phoenix Helix is a great blog to check out in this department) who feel a decrease in pain. RA is in the same family of connective tissue autoimmune diseases. Hope you start feeling better soon!

Hi, I have stage IV endometriosis and work in dialysis, so I’m always worried about taking ibuprofen. I bought the brand Oona as recommended at my health store, which is cramp bark and ginger. Have you heard anything about it? I’d like to try your brand as it’s $10 vs $25 for the same amount.

This blog has been so encouraging and helpful to me during my recent diagnosis-sh with autoimmune disease (looking like it is probably Lupus). I am a 29 year old female with four small children (6,3,3,1) living in Kentucky with no history of health problems other than several late miscarriages and gestational diabetes. On 12/23/15 I was prescribed Domperidone (off the market drug that had to be compounded at a special pharmacy) from my OB to increase my breast milk supply. A few weeks later in the beginning of January I began with joint pain in several fingers in my right hand, left elbow and knee. I brushed off the pain for a while and then realized I couldn’t have possibly injured myself in all those joints at the same time. Went to PMD and was told I was probably holding the baby in a funny way that was causing strain. I begged for testing just for peace of mind. Labs came back with positive ANA and anti double stranded DNA. I went through a few days of really grieving this likelihood of Lupus and then discovered AIP- I quickly purchased your book and two others from Paleomom. I also found research on Domperidone causing Lupus like syndrome. Within two weeks on AIP and off Domperidone my symptoms completely went away. I had to wait until mid April to get into the Rheum and was steadfast on AIP for three months until I convinced myself that I didn’t actually have an autoimmune disorder and that I probably had drug induced Lupus from the Domperidone. I started allowing myself a cheat meal once a week and by the second week of April (one week off strict AIP) my joint pain returned. Saw the Rhem about 4 days after joint pain returned and he said it was definitely not drug induced if my joint pain returned after three months of symptom free. He said I didn’t appear to have Lupus and only met three of Lupus critera (4 are needed for official dx) but since I had anti ds-DNA he could not tell me that I didn’t have Lupus. He threw around the idea that I may have early onset Lupus and just haven’t developed other symptoms yet. I had labs re-drawn for every sort of auto immune disorder and all my blood counts were within normal limits except my ANA and anti ds-DNA. Since mid April my joint pain has spread to new joints and worsened. I am back to strict AIP and have within the past week added tumeric supplements and Glucosamine-Chondroitin-MSM. In the last few days I have noticed a mild relief in my joint pain. I have been doing some research on Bromelain as well. I apologize for leaving such a lengthy and personal comment on this section but was hoping to connect with anyone with similar circumstances. From my understanding, anti ds-DNA is super specific for Lupus. This makes me believe that I have early onset Lupus even thought the Rhem was not able to officially tell me that. Do you have any insight into whether AIP can give me realistic hope of slowing or stopping the progression of joint pain/damage? I have read most all of the success stories on this blog and can only recall one that mentioned a dx of Lupus. If anyone reading this has any encouragement or insight about the relationship with AIP and anti ds-DNA, I would be really grateful to hear.

Hi Tereza! Wow, I am sorry to hear your story and I can relate, as I was “almost” diagnosed with lupus during my health crash. I did not have positive antibodies, but other criteria at the time–the worst was pleurisy, which is inflammation of the lining of the lungs. Once I discovered AIP the symptom went away and never returned, and I never got the lupus diagnosis. Have you found any lupus support groups on FB where you could ask this question?

Since I’m not a medical practitioner and can’t advise on medical conditions, I can’t tell you if AIP will specifically help with lupus. If you’ve read the stories on our site though, you will see some of the experiences others have had with the elimination diet.

I have endometriosis and have been on hormone therapy medication for 2 years but would like to get off them which my doctor has okayed. I have eliminated dairy and wheat from my diet with great results in chronic pain but have noticed flare ups and am now excited to embark on the AIP diet. Would you recommend staying on hormone therapy medication like Visanne while starting AIP or making the changes all at once? I’m worried about putting undue stress on my body trying to do it all at once. My doctor said it didn’t matter when I stopped it as diet doesn’t affect my other symptoms :/

Hi Shay! Unfortunately, as I am not a medical practitioner I can’t advise on medication–that is a conversation and decision you’ll have to make with your doctor. I know people who have had good results trying an elimination diet while on medication, then trying to wean off the medication once they have made the transition (with their doctor’s supervision and approval, of course!). Every situation is different. Hope you are able to start feeling better soon!

I just posted a question and realized after I submitted that I didn’t say thank you for your answer (I realize a thank you in advance, but I like to do that. 😊) So here is the thank you and for your answer to my previous question posted over a year ago. You and Angie are so very encouraging and resourceful!

I am planning to start the AIP diet very soon (within the next few days). Unfortunately I had ankle surgery on Dec. 7th and am still experiencing a lot of pain and swelling. I don’t think that I will be able to go without NSAIDs for awhile. Do you think it’s still worth trying to do AIP even though I can’t stop the NSAIDs yet?

My chiro put me on multiple doses if Nordic Naturals Fish oil for about 4 months. I had tried other brands before, but had side effects and affected my digestion. As added benefit, my seasonal allergies disappeared too. When ever they flare, I up my dose for a few days. My mother finally used the XL Omega brand that is safe for those allergic to seafood s, and that worked well for her. After a while her allergy to fish went away, and she switched to Nordic also, w/o any side effects. She was onbloodthinners at the time, but both Dr and pharmacist Okayed it. Maybe it’s the type you use, as in our case.

Dear Mickey, I really appreciate your wonderful website, which I am very new to. Speaking of new, I’ve only been on the AIP diet for about two weeks now. I’m specifically trying to eradicate migraines, which is one of my autoimmune issues. I was wondering if you have any suggestions. I will try the White Willow Bark for pain in the meantime…Have a great AIP day !

Hey Lynn! I suggest working with an AIP Certified Coach to troubleshoot and see if you can get at the root of your migraines – it can be many things, like histamine intolerance. We have a listing here: http://aipcertified.com. Good luck!

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